| NPI | 1801182860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A124240) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS 23936) |
| 208000000X Pediatrics (Licence: GA 4803) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2024-10-28 |